In March, I attended the American Occupational Therapy Association (AOTA) conference and learned about the World Federation of Occupational Therapy (WFOT). This piqued my interest in finding out more about Occupational Therapy in a global context. Then, this fall, in an OT Health Administration class, I attended a guest lecture by Professor Amy Carroll, who visits India frequently. Since I am a first generation Indian living in the United States (my parents immigrated to the U.S. in 1987), I was inspired to learn more about OT in India, and thought it would be interesting to compare differences and similarities across cultures. I got the chance to do that in mid-July when my family and I traveled to the southern state of India known as Kerala to visit family and friends. I had just completed of my first year in the entry level master’s program in occupational therapy (EMOT).

After finishing a clinical rotation in a school for physical disabilities during the fall semester, I was especially interested in pediatric neurodevelopmental disorders and hoped for the opportunity to observe at a pediatric OT clinic during my stay. From my research I found the Prayatna Centre for Child Development in Kerala, a multidisciplinary outpatient clinic consisting of OT, PT, speech therapy, special education, counseling, and other services, for children with developmental delays. I was informed that they provided opportunities for learning experiences in their department of occupational therapy, so I made arrangements for a one-day visit on July 18.

I thoroughly enjoyed my observation day at Prayatna; all the staff members were truly welcoming. The senior director, Dr. Joseph Sunny, provided me with the initial orientation and called a meeting with a formal introduction to each of the therapists and staff members where I was asked to share information about my OT education in the United States. It was especially interesting to learn that clinicians in India can practice with a bachelor’s degree; a master’s degree is pursued to gain further competency and skills in a desired area of practice. For example, many of the therapists had a bachelor’s in occupational therapy (BOT) and a master’s in occupational therapy (MOT) in pediatrics. I also discovered that the director knew my family name, as he grew up in the same town as my parents.

A member of the Prayatna Centre Staff introduces Abby.

I was able to understand the Indian dialect Malayalam being spoken in a clinical setting. Malayalam is a common language spoken in the Southwestern Indian state of Kerala, and it is my family’s first language. It’s one thing to observe occupational therapy in a different country, but to experience it being delivered in your native tongue is extraordinary! I found it fascinating to have a similar cultural background with many of the patients and staff, and I could see how this could be quite beneficial in practice. It was also intriguing to compare cultures. Because of my work as a graduate assistant in the Honickman program that teaches at-risk youth in North Philadelphia, I have developed a concrete concept of culture after being familiarized with specific cultural literacy curricula. Therefore, observing OT in this context allowed me to experience cultural competency and sensitivity at the next dimension through direct immersion.

Some of the striking differences were that the therapists did not wear shoes in the building, most children and adults eat with their hands, and many come to work dressed in traditional Indian clothing. I was able to explicitly examine the importance of how values, beliefs, and practices can directly impact Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) specific to one culture. Because of the warm climate in India, most people wear sandals, which are easy to slip off when they enter public and private places in the community. In the U.S., strategies for shoe-tying are a common pediatric intervention focusing on self-care; in India it would be an uncommon one. Another example is that of making tea since it is customary to serve tea in stores, clinics, offices, etc. Therefore, the IADL of making tea would be applicable and more common in an OT treatment session in India because it is directly relevant to the culture.

Abby addresses the staff to tell them about OT/PT education in the United States.

I found it intriguing to observe and engage with treatment sessions across OT, PT, and speech therapy. There was a primary emphasis on sensory integration and Neurodevelopmental treatment in the interventions, which was similar to the way I’ve seen it conducted in the U.S. The equipment in the OT gym was quite comparable too, and the environment was specially set up as a sensory room with a ball pit, different tactile input, swings, and yoga balls.

Through discussions with Dr. Sunny, and through observations during my stay, I noticed the stigma on disability and a lack of awareness of occupational therapy in Southern India. Multiple factors at play—including socioeconomic status, education, and geographic location—contribute to health inequities.

According to a recent article in the Indian Journal of Occupational Therapy, due to the underdevelopment of many areas, very few people have access to rehabilitation services. In addition, having a child with a disability can still be considered shameful in some families, bringing about prejudice and harsh judgment from the public. This results in a hesitancy to seek assistance and habilitation services, leading to a lack of desire to instill independence in a child with a disability. The lack of funding for resources and technology to increase participation in the services leads to the exclusion of those with disabilities from valued occupations. My visit helped to further instill in me a passion for advocacy and the belief there is potential for program development and funding for further technology in India that I can see in my career trajectory.

I went to India with the objective of gaining an understanding of occupational therapy practice there, and was completely satisfied. Ultimately, I think it is essential for aspiring healthcare professionals to immerse themselves in a culture outside their own to better one’s understanding of cultural sensitivity and client-centered practice.

Unfortunately, I could only visit the Prayatna Centre for one day, but I hope to return to India in the next few years. Dr. Sunny serves as the president of the Kerala branch of the All India Occupational Therapy Association (AIOTA), and informed me that the annual conference in 2020 will take place in Cochin, Kerala, India. He suggested this would be a great opportunity to connect with exhibitors who will be present, as well to implement and educate current clinicians on the latest innovations. Overall, it was a great experience that definitely exceeded my expectations.